Matching Wounded Warriors with Assistive Technology

Family Caregiving, Military Families January 09, 2014 Print Friendly and PDF


If you are a wounded service member with questions about assistive technology, or you care for such a person, it is important to understand the process of selecting assistive technology devices (ATDs). An ATD is any item, piece of equipment, or product system used to increase, maintain, or improve functional capabilities of an individual with a disability. ATDs are meant to help with mobility, communication, hearing and seeing, and such everyday activities as personal care and independent living. Cognitive support technologies are a class of ATDs designed to help with memory, attention, concentration, executive functioning (used to perform activities such as planning, organizing, and managing time and space), and so on.

Wounded service members are the fastest-growing population needing ATDs. According to an American Forces Press Service news article, the Computer/Electronic Accommodations Program (CAP)1 received more than 3,500 requests from wounded service members in 2008 (Cragg, 2008). CAP provided 6,693 accommodations to wounded service members in fiscal year 2011 (CAP Annual Report 2011, p. 1) and 5,504 in fiscal year 2012 (CAP Annual Report 2012, p. 2). These figures are significant, but they do not provide information about the realization of benefit gained from the obtained ATDs or about the number of service members who could have benefited from CAP but did not request accommodations.

Although a succession of US statutes encourages provision of ATDs and federal mandates exist for comprehensive, consumer-responsive ATDs and related services, obtaining the devices often remains challenging for both service members and providers. The appropriate match of person and technology requires attention to user needs and preferences, aspects of the environments of use, and device functions and features. If the match is not a quality one from the standpoint of the user, he or she may not use the ATD optimally or at all. In fact, the overall discard or abandonment rate of ATDs for the past 30 years is 30 percent (Scherer, 2014). With almost 40,000 different ATDs available, this discard or abandonment rate likely is due not to a lack of products but to deficiencies in technology selection and service delivery.

Reports showing high levels of ATD choice overload and ATD dissatisfaction and hassle in addition to nonuse indicate that an improved evaluation and decision-making process is needed. The Matching Person & Technology (MPT) model, with its accompanying assessment instruments (Scherer, 2005), is a resource intended to ensure that someone needing assistive technology acquires the optimal device for his or her situation. The set of assessment instruments has been validated for persons with disabilities of all ages and disability types, and implementation of this set of instruments has resulted in increased ATD use and greater realization of benefit from use. The MPT model organizes and addresses the influences that affect ATD selection and use. These influences are categorized as personal factors (for example, user priorities and preferences), environment factors, and technology functions and features (see Figures 1 and 2).

 

Considerations in Multiple Domains for Achieving a Good Match of Person and Technology

Getting to know any particular person is a multi-faceted endeavor. The first and last step in achieving a good match of person and technology is to conduct a thorough assessment of the person, his or her environment(s), and potential technology options.

The characteristics and resources of the person can be organized into five domains. Within each domain, various factors must be addressed, such as the following sample key considerations:

Needs, capabilities, and preferences

  • What are the person’s strengths, interests, and priorities?  What are the person’s dreams and goals? That is, what gives the person purpose and meaning in life and motivates him or her to take action?
  • Does the person have the essential requisite skills to use the technology to maximum advantage? For example, does he or she have keyboard skills? 

Prior exposure to and experiences with technologies (and other supports)

  • What is the person using or doing now?
  • What has worked well?

Adjustment

  • Does the person perceive a discrepancy between the current situation and the desired situation?

Expectations, mood, and temperament

  • What blend of autonomy and support from others does the person want to achieve?

Lifestyle

  • What are the typical routines of the person at work/school or home? (It can be more difficult to adjust to using technologies that interfere with customary routines.)

Next, considerations related to the characteristics and requirements of the environments of use and their impact on the individual become key. When exploring this area, it is important to keep in mind that an environment consists not only of physical objects but also of people (with their varied attitudes and values). What can be done to help the person function better and develop a sense of belonging and connection in his or her environments? Within the domains related to characteristics and requirements of the environments of use, the following sample key considerations must be applied:

Cultural

  • Within the person’s familial culture, what have been his or her experiences and opportunities?
  • Will the person’s peer group be supportive of his or her use of the planned technology? Or is technology use apt to set the person apart from peers?

Attitudinal

  • What are the predispositions of relevant caregivers to using a technology with the person?
  • Have additional supports and assistance been considered, and are they available if needed?

Physical

  • Are all the necessary supports in place for the person to access and use the planned technology?
  • If assistance is required for training and use of the technology, is it available? 
  • Do relevant settings need to be reorganized?
    • Is adequate space available?
    • Is the lighting sufficient?
    • Will the person need to be near an electrical outlet?

Legislative/Political

  • Are relevant parties familiar with all legislation applicable to use of the planned technology?
  • Have additional supportive resources in the community been identified?

Economic

  • What are the repair and maintenance requirements of the technology, and how much do they cost? 
  • Will the vendor provide onsite services? At what cost?
  • How often are upgrades available, and how much do they cost?

Characteristics of the particular technology (or other support) being considered is the last category to be addressed. As discussed earlier, technology devices and technology services are two halves of a whole. The following sample key considerations are involved in the domains related to characteristics of the proposed technology:

Availability

  • How available is the technology? Can it be obtained in a timely fashion?
  • Will it need adjustment or setup?

Appearance

  • How compatible is the technology with desired social activities?
  • ​Does the person feel self-conscious using it? 

Comfort

  • Does using the technology cause fatigue, strain, or pain?
  • Is the technology easy for the person to use, transport, and set up?

Performance

  • Does the technology support the person’s varying abilities?
  • How easily and quickly can servicing and repairs be done?
  • If the person already uses a device or devices, will the new technology interface well? Or is a point of overload being reached?

Cost

  • What are the relative advantages to purchasing, leasing, or renting the technology? 
  • Are there effective alternatives that cost less?
  • Are warranties and guarantees available?
  • Can the technology be serviced locally, or must it be shipped elsewhere?
  • Is on-going training and support built into the cost or an upgrade?

In addition to the considerations listed above, the MPT model provides other questions related to each category of influences that affect ATD selection and use. After all such questions have been answered, one product should emerge as more desirable than others. The next steps are to obtain the product and to put in place the resources supporting its use. The MPT model provides additional guiding questions for these steps.

After the person has used the technology in actual situations and natural settings for a trial period, feedback should be sought regarding how well the technology is performing for the person and how the person has changed in capability and realization of benefit. Obtaining this feedback ensures that evaluation of the technology as an intervention is based on evidence and measured outcomes.

Note

  1. The Computer/Electronic Accommodations Program (CAP), a program in the TRICARE Management Activity (TMA), was established in 1990 as the centrally funded Department of Defense (DoD) program that provides assistive technology to allow DoD and federal employees with disabilities to access electronic and information technology. CAP works closely with medical providers, therapists, case managers, and wounded service members across the nation to ensure that wounded service members receive assistive technology as needed. Accommodations are available for service members with vision or hearing loss; dexterity impairments, including upper extremity amputation; and communication and cognitive difficulties, including traumatic brain injury and posttraumatic stress disorder. 


Contributor

Marcia Scherer, Ph.D., President of the Institute for Matching Person & Technology

Acknowledgments

The MPT model materials have been developed through support from the following entities:

  • National Science Foundation

  • National Institutes of Health

  • Centers for Disease Control and Prevention

  • National Institute for Disability and Rehabilitation Research

  • Various European Union–based projects

Sources

 Cragg, J. (2008, June 2). Wounded Troops Increasingly Demand Assistive Technology. US Department of Defense American Forces Press Service. Retrieved from http://www.defense.gov/news/newsarticle.aspx?id=50071.

Scherer, M.J. (2005). The Matching Person & Technology (MPT) Model Manual and Assessments, 5th edition [CD-ROM]. Webster, NY: The Institute for Matching Person & Technology, Inc.

Scherer, M.J. (2005b). Living in the State of Stuck: How Assistive Technology Impacts the Lives of People with Disabilities, 4th edition. Cambridge, MA: Brookline Books.

US Department of Defense Computer/Electronic Accommodations Program Annual Stakeholders Report Fiscal Year 2012. Retrieved from http://www.cap.mil/AboutCAP/AnnualReports.aspx.

US Department of Defense Computer/Electronic Accommodations Program Annual Stakeholders Report Fiscal Year 2011. Retrieved from http://www.cap.mil/AboutCAP/AnnualReports.aspx.

For More Information

Reviews of and details on the psychometric properties of the MPT assessments can be obtained from these databases (as well as others) and journal articles:

  • Outcome Measures Database, Spinal Cord Injury Rehabilitation Evidence (SCIRE) project
  • Rehabilitation Measures Database
  • Scherer, M.J., & Craddock, G. (2002). Matching Person & Technology (MPT) assessment process. Technology & Disability, Special Issue: The Assessment of Assistive Technology Outcomes, Effects and Costs, 14(3), 125-131.
  • Scherer M.J., Craddock G., & Mackeogh T. (2011). The relationship of personal factors and subjective well-being to the use of assistive technology devices. Disability and Rehabilitation, 33(10), 811-817. PMID: 20735272.
  • Scherer, M.J., Sax, C., Vanbeirvliet, A., Cushman, L.A., & Scherer, J.V. (2005). Predictors of assistive technology use: The importance of personal and psychosocial factors. Disability and Rehabilitation, 27(21), 1321-1331. PMID: 16298935.

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This work is supported by the USDA National Institute of Food and Agriculture, New Technologies for Ag Extension project.